CPAP modems and remote changes to your settings without your knowledge

[Melman]

If you want to benefit from insurance coverage, however, you need to use a DME that is in network. If covered by medicare you need to use a Medicare approved DME. For most, copay costs after insurance coverage will be much lower than what is charged by the best internet suppliers. Your Dr. shouldn't be able to dictate which which DME you use but your insurance or Medicare can if you want to benefit from the coverage.

[kiwii]

If you want to benefit from insurance coverage, however, you need to use a DME that is in network. If covered by medicare you need to use a Medicare approved DME. For most, copay costs after insurance coverage will be much lower than what is charged by the best internet suppliers. Your Dr. shouldn't be able to dictate which which DME you use but your insurance or Medicare can if you want to benefit from the coverage.

Yes, this is how I thought it worked.

How is it his Doctor can say that the DME is the only one he will work with? Seems to me that you get the Rx, and then take that wherever you'd like within your insurance approved choices.

Hadn't realized how much I am inclined to swear when the topic of DME's and sleep doctors comes up. It took some amount of effort to leave the expletives out of that paragraph.

[SarcasticDave94]

Quoted from kiwii post #152 above here, "How is it his Doctor can say that the DME is the only one he will work with?"

I bolded the word "say". Why? Anybody can say this or that will be a certain way. IMO legally they cannot enforce it. So in this context, again IMO, doc can say whatever, but he can't enforce that action.

Insurance can say it, whatever it is, and enforce it, as in "you want us to pay, you see this doc, this DME, etc. on our terms or we won't pay".

[kiwii]

But SuperSleeper isn't a noob. Something must be different here.    

Somehow he is being forced to use a very bad DME. (unless, of course, he pays out of pocket)

How can this be happening?

edit: is it possible for an insurance to only allow one DME?

[SarcasticDave94]

But SuperSleeper isn't a noob. Something must be different here.    

Somehow he is being forced to use a very bad DME. (unless, of course, he pays out of pocket)

How can this be happening?

edit: is it possible for an insurance to only allow one DME?

Of course SS isn't a noob. And not being harsh or such, to answer some of the following forces speculation I'd rather not venture into and crosses my "right to know" certain specifics about anyone else's biz.

Generically though, on the insurance side, yes I think they can choose ONE DME. If I'm wrong, publicly correct me on that so I learn the right answer.

Happy Easter eve...that exists right?



PS closest example I have to ONE DME thing: for back issue, the PA-C referred me to get acupuncture. One place within X miles was in network.

[kiwii]

Oh! I didn't mean to pry into his business. Sorry, SuperSleeper. I didn't mean to pry into anything personal.

I meant that I thought HIPPA protected against certain things, and I thought our right to choose was one of them, and was wondering if I was wrong. Which seems very scary to me. That's all.

[SarcasticDave94]

Oh! I didn't mean to pry into his business. Sorry, SuperSleeper. I didn't mean to pry into anything personal.

I meant that I thought HIPPA protected against certain things, and I thought our right to choose was one of them, and was wondering if I was wrong. Which seems very scary to me. That's all.

My apology, but that was a "ME" thing only. I'm not implying I know some "rest of, or the inside" story. I don't, and don't want to. Anyway, I muddled my way wrongly attempting to answer generically. Sorry also to SS and all A.B. for awkward moment I created.

Peace to all and happy Easter.

[Walla Walla]

Ah yes the Dave Two step.

[JesseLee]

I know that Medicare will have providers for equipment and supplies based on some bidding process and you are locked in on dme providers that Medicare says you have to deal with if you want Medicare to provide for you. This is regional policy and in some cases product specific.
Doctors, no. Insurance can deny when they feel fit and who they feel fit.

[SuperSleeper]

Of course, I do have a choice - but if I want my insurance to pay for CPAP and regular supplies, it has to be a provider that is in-network.  There are other DMEs around the nation that this insurance company works with and are also in-network.  But I would have to travel over an hour to get to the closest in-network DME, which I'm trying to avoid not only for getting the CPAP, but also for ongoing supplies.  Don't want to make a 2+ hour round trip every time I need filters or nasal pillows.

Yep, I do have choices, but they would involve extra expense on my part for travel and time.  When one pays for insurance, one tries to use that insurance, especially since they will pay for your machine.

Of course, I could chuck the local DME and go online to purchase a machine outright and order my supplies through Supplier #1 like I've always done in the past.

But now that I have insurance, I'm simply trying to get them to pay for medical supplies in order to control my own costs, so I'm currently "playing their game".

So, I've chosen to play nice in the sandbox with them (even though they're morons).  I would love nothing better than to "tell off" this DME and point them to a Wiki article refuting everything the RT told me.  But again, getting them irritated at me would only make them that much more difficult to deal with going forward.

Due to other medical issues, I'm likely to need this DME for other equipment/supplies in the future. I don't want to burn a bridge that I may need to cross in the future.

Sometimes a man has choose which battles he fights.